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This bone was removed centrally until a thin cap remained. After removal of the cap, the underlying ligamentous tissue was removed until dural pulsations were appreciated and brainstem decompression achieved. Hemostasis was attained and the mucosal flap mobilized into position. Results Postoperative CT imaging demonstrated resolution of basilar invagination and brainstem decompression ( Fig. 1 ). The patient improved both in arm dexterity and ambulation after surgery and the reconstruction demonstrated appropriate healing on nasal endo
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